Year: 2024

Health inequities affecting people with disabilities remain a persistent and often overlooked issue within the U.S. healthcare system. Despite efforts to make healthcare more inclusive, provider biases and financial challenges continue to prevent millions from receiving equitable care. With recent policy pushes for broader health equity, now is the time to address the unique needs of this population.

Provider bias and a lack of training on disability-specific care create another layer of inequity. Many healthcare providers have limited knowledge of the unique healthcare needs and challenges faced by people with disabilities. The National Council on Disability (NCD) reports that these gaps in provider training lead to miscommunication, inadequate treatment, and a lack of understanding about the disabilities themselves. This can result in healthcare providers making assumptions about patients’ quality of life or failing to take complaints seriously, impacting the overall quality of care. Addressing these biases is crucial to ensure that providers offer compassionate, informed care that respects everyone’s needs.

Individuals with disabilities often encounter significant financial challenges that impede access to necessary healthcare services. These challenges stem from increased medical expenses, limited employment opportunities, and systemic economic disparities. A comprehensive report by the Financial Health Network reveals that nearly half (46%) of working-age individuals with disabilities have unmanageable levels of debt, and only 51% can pay all their bills on time. This financial instability is exacerbated by the fact that people with disabilities are more likely to live on low incomes. The National Disability Institute reports that 45% of working-age individuals with disabilities have annual household incomes under $30,000, compared to 21% of those without disabilities. Public safety net programs, such as Supplemental Security Income (SSI) and Social Security Disability Insurance (SSDI), are intended to support individuals with disabilities. However, only about a third of working-age individuals with disabilities receive these benefits. Even among those with low incomes and significant barriers to employment, many do not receive the assistance they need. These financial barriers not only limit access to healthcare but also contribute to a cycle of poverty and poor health outcomes. Addressing these challenges requires comprehensive policy interventions aimed at improving employment opportunities, enhancing public benefits, and reducing the additional costs associated with living with a disability.

Recent policy efforts seek to address these disparities, but much work remains. The Americans with Disabilities Act (ADA) laid an essential foundation for disability rights, yet it does not mandate comprehensive healthcare accessibility or provider training. The National Council on Disability’s 2024 Progress Report recommends that policymakers enhance provider training in disability care, increase funding for facility accessibility improvements, and expand Medicaid and Medicare services to cover a broader range of disability-specific needs.

Ensuring health equity for people with disabilities will require more than incremental improvements; it demands systemic change. Addressing physical, educational, and financial barriers within the healthcare system is crucial. By pushing for stronger policies, comprehensive training, and expanded financial support, we can bridge the gap and create a healthcare system that serves everyone equally. Ongoing advocacy and reform are essential to ensure that all individuals, regardless of disability, receive the quality care they deserve.

Health insurance is a legal entitlement to payment or reimbursement for health care costs. At its core, health insurance is supposed to provide important financial protection for health care costs in case of accident or sickness in exchange for a monthly premium. It can also help people when they are not sick by covering routine check-ups and many preventative services.

Health insurance is especially important for society since health is a universal experience that all people will be impacted by. While some insurance plans, like car or homeowners, are there in case an accident or natural disaster occurs, health insurance is different because there aren’t rare occurrences that trigger the need for insurance. Instead, health insurance covers not just accidents or emergencies but also routine care that is meant to maintain health, enhance one’s quality of life, reduce the risk of developing serious diseases, and address any existing or new conditions. 

When health insurance falls short the consequences are tragic. Those who have suffered an accident, injury, emergency, sickness, or disease are at risk of life-long financial debt. While health insurance is a business and it is expected for businesses to mitigate costs to be successful, certain strategies are causing significant consequences to those who have received medical care. For instance, health insurance companies will typically use an in-network and out-of-network plan for costs to be reduced. As long as a patient has access to the care they need, this strategy does not inherently create an unreasonable burden on the health insurance’s beneficiaries. Additionally, beneficiaries will receive descriptions of what the health insurance covers and what is excluded which depends on the plan. However, beneficiaries are at unnecessary risk of medical debt because health insurance holds all of the power in this relationship and abuses this power by deciding whether or not care is “medically necessary” after the patient has received the care which allows the company to refuse to cover any costs that it is designed to provide for. 

Imagine someone who had a heart attack and to resuscitate them, the health care providers use a defibrillator, and then after they realize that the health insurance company has decided that the defibrillator was not medically necessary and will not be pay for it. A beneficiary should not have to decide upon whether or not to receive a life-saving measure nor should the beneficiary be stuck with medical bills that put them in life-long death just for surviving. Unfortunately, one wouldn’t have to use their imagination for this scenario as a survey showed “one in five Americans said their health insurance company had denied a claim over the past 12 months”. Health insurance companies have increasingly been using artificial intelligence (AI) to reduce costs by accelerating claims, coverage, and prior authorization decisions. However, the consequences are grave, an investigation found that in 2022, Cigna (a health insurance company) used an AI technology to deny or reject more than 300,000 claims for services or care that clinicians considered medically necessary. “Between 2022 and 2023, denials rose more than 20 percent for private, commercial claims and nearly 56 percent for MA [Medicare Advantage] claims.” The American Medical Association has called for regulatory guardrails against health insurance companies using AI in this way. However, without strict government regulations, health insurance companies will be continually motivated to deny claims by labeling them medically unnecessary so the company does not have to pay.

Until there are laws or government regulations to protect patients from these inappropriate denials of health care claims, patients must protect themselves. AI is not just for health care providers or health insurance companies but patients can use AI to help them fight the health insurance companies. While AI is contributing to an increased number of claim denials, a high number get overturned but that requires the beneficiary to go through an appeal process. Data suggests that more than half of the claims initially denied can eventually be overturned by appeals. However, this process is purposefully difficult. A new tool uses AI to help patients draft a letter for the appeal process using the letter of denial from the insurance company and the individual’s review. This tool helps people know how to appeal, what to include, and quickly draft the document. The company is hopeful this helps insurance companies change practices by increasing the amount of successful appeals but until the health insurance companies change, people who have suffered can fight back.

The Family and Medical Leave Act (FMLA) guarantees eligible employees up to 12 weeks of unpaid leave each year to care for a newborn, newly adopted child, and/or a seriously ill immediate family member, or to recover from their serious health condition. FMLA also provides up to 26 weeks of leave to care for a covered service member with a serious injury or illness. Signed into law by President Bill Clinton in 1993, the FMLA has since allowed millions of American workers to take time off without the risk of losing their jobs or health insurance.

While FMLA offers job-protected leave to many American workers, over 40 percent of the workforce remains ineligible. The FMLA applies only to employers with 50 or more employees, public agencies, and public schools. Employers must also provide group health insurance to meet the requirements of the Act. In general, eligible employees must have worked for the covered employer for at least 12 months, accrued at least 1,250 hours of service during the previous 12 months, and report physically to a worksite where at least 50 employees work within 75 miles.

The United States Department of Labor (DOL) Wage and Hour Division released guidance to address concerns regarding the physical worksite requirement. Before COVID-19, remote work was less common, but with digital jobs expected to increase by 25% globally over the next six years, concerns about FMLA eligibility for remote workers have grown. For FMLA eligibility purposes, an employee’s residence is not considered a worksite. Whether or not to include remote employees in FMLA coverage has raised questions for employers. In the 2023 Field Assistance Bulletin, the DOL clarified that an employee’s worksite for FMLA eligibility is the office to which they report or from which their assignments are made. This effectively limits remote workers’ access to protected leave under FMLA.

Another key concern regarding FMLA is whether certain health conditions, including mental health issues, qualify as “serious health conditions” under the Act. Generally, to meet the criteria, a health condition must involve inpatient care at a hospital or medical facility, incapacitating conditions requiring ongoing medical treatment, or childbirth. As of November 2024, the DOL Wage and Hour Division has concluded 349 FMLA compliance actions, with violations resulting in the recovery of more than $1.48 million in back wages for 344 affected employees. The most common FMLA violations include denial of leave, failure to reinstate employees to their same position or benefits, termination, and discrimination.

Access to FMLA is not equally distributed across the workforce. Many workers report returning from leave only to find their benefits have been canceled, or that their job or performance evaluations have changed. Racial, ethnic, and class disparities in access to and use of FMLA are increasingly being documented across the job market. Data from the National Compensation Survey shows that low-paid workers are less likely to have access to paid leave than higher-paid workers. Research by the United States Bureau of Labor Statistics also reveals that Hispanic workers have lower rates of paid leave access than their White non-Hispanic counterparts and that disparities in paid leave access also exist based on factors such as education and employment status. These disparities highlight key issues and opportunities for reform in the nation’s policy on unpaid leave for serious health conditions.

On Thursday, November 14^th, 2024, President-elect Donald J. Trump announced that he was nominating Robert F. Kennedy Jr. to oversee the Department of Health and Human Services (HHS). This nomination came as no surprise since Trump has continuously voiced that Kennedy would play a role in his upcoming administration by helping him make “America healthy again.” 

Despite RFK Jr.’s vaccine skepticism and rather unconventional views on medicine, there is still a decent chance that his nomination gets confirmed by the Senate as only a simple majority—51 votes—is needed and the GOP now holds 53 of the 100 seats in the Senate. With RFK’s potential confirmation on the horizon, Americans should begin thinking about what the country’s state of health, specifically for the country’s children, will look like over the next four years.

One change that RFK Jr. plans to implement as HHS Secretary is the removal of fluoride from America’s drinking water. According to RFK Jr., fluoride is “an industrial waste associated with arthritis, bone fractures, bone cancer, IQ loss, neurodevelopmental disorders, and thyroid disease,” but it should be noted that RFK Jr. lacks a medical background and has a history of spreading misinformation based on conspiracy theories. 

According to the Centers for Disease Control and Prevention (CDC), fluoride is a naturally occurring mineral and when it combines with outer tooth enamel it makes teeth stronger and more resistant to decay. In other words, the addition of fluoride in America’s drinking water helps ensure the health of citizens as the mineral helps prevent the formation of cavities. The federal government first began endorsing water fluoridation in 1950 and the passage of the Safe Drinking Water Act in 1974 designated water fluoridation as a state, not federal, responsibility. Water fluoridation is therefore not federally mandated, rather state and local governments decide on whether to implement water fluoridation in their communities. 

The CDC considers water fluoridation a cornerstone strategy for preventing cavities in the U.S. as it is a “practical, cost-effective, and equitable way for communities to improve their residents’ oral health regardless of age, education, or income.” Studies have also shown that fluoridated water reduces cavities by about 25 percent in both children and adults which provides multiple benefits such as “less mouth pain, fewer fillings or teeth pulled, and fewer missed days of work and school.” Additionally, the CDC estimates that communities that have implemented water fluoridation save about $32 per person a year since there is less of a need to pay for cavity treatments.

Although small amounts of fluoride in our water are beneficial, large amounts of the mineral over a long period of time can lead to the development of dental fluorosis in children, which is a condition that affects the appearance of teeth by causing the outer enamel layer to have white flecks, spots, or lines. While concerns over this condition are warranted given the increasing number of sources that contain fluoride including toothpaste, mouthwash, and even some beverages, HHS released a guidance in 2015 that accounted for these increased risks and advised community water systems to adopt a uniform concentration of 0.7 mg/L of fluoride in drinking water which ensures cavity prevention benefits while also minimizing the risk of dental fluorosis. 

In August of this year, HHS released a report that found higher levels of fluoride exposure, such as drinking water containing more than 1.5 mg/L, are associated with lower IQ in children. The agency has stated that the study “does not, and was not intended to, assess the benefits of fluoride” and that there is a need for further research to better understand whether there are health risks associated with low fluoride exposure.

If RFK Jr. does get confirmed, communities across the U.S. will see an end to water fluoridation. Drinking water will still contain a minimal amount of naturally occurring fluoride, but the amount is so small that Americans will cease to see any oral health benefits and instead are going to see an increase in their dental bills.  

Over the last decade, private equity (PE) investment in healthcare has surged, impacting everything from small, private physician practices to major hospital systems. In fact, PE buyouts of physician practices increased by six times from 2012 to 2021. PE’s business model is designed for swift financial returns, with major profits only realized upon sale, which usually happens within five to eight years. This model has sparked debate over its seeming incompatibility with healthcare’s mission to prioritize patient welfare.

PE firms use funds from investors to acquire equity stakes in target companies, which they work with to make “more valuable” and later sell at a profit. The firms use substantial debt to finance their acquisitions. This debt is then placed on the balance sheet of the acquired entity. Next, they look for ways to cut costs rapidly in preparation for a profitable sale. This places pressure on PE firms to prioritize profit margins over long-term stability, even if this means the target entity struggles or goes bankrupt after the firm leaves. This model has substantial repercussions for patient safety and quality of care. A 2023 study published in JAMA by researchers from Harvard Medical School and the University of Chicago found a 25% increase in adverse events in PE-acquired hospitals as compared to non-acquired hospitals. These adverse events included situations such as staffing levels and inconsistent patient safety protocols. 

Regulatory bodies at the state and federal levels have begun paying attention and are addressing the issue.  A rising number of states have enacted or proposed “mini-HSR” laws—modeled after the federal Hart-Scott-Rodino Act, focusing on any transactions that could lead to the consolidation of healthcare markets. As of today, only Indiana has enacted a law that expressly mentions PE transactions in healthcare. Under Indiana’s mini-HSR Act, effective on July 1, 2024, a transaction involving a PE partnership and a healthcare entity is likely to undergo regulatory review. In comparison, Washington’s mini-HSR Act may require a hospital system owned by a PE firm to ascertain the healthcare assets of other portfolio companies of the same firm. States like California and Massachusetts have proposed similar laws. California’s much-watched Assembly Bill 3129 (AB 3129), would have required a 90-day notice to the Attorney General before concluding any transactions involving PE and healthcare facilities. However, on September 30, 2024, Governor Newsome vetoed this bill, due to its overlap with the Office of Health Care Affordability (OHCA) which already oversees healthcare transactions and can collaborate with the Attorney General if needed. This veto signals a significant win for PE and healthcare stakeholders.

The federal government has also turned its attention to PE’s role in healthcare. The Health Over Wealth Act, introduced by Senator Ed Markey (D-MA) and Representative Pramila Jayapal (D-WA), aims to increase transparency by requiring PE-owned healthcare providers and for-profit healthcare companies to publicly report financial and operational data, including their debt, profits, and any reduction in services or worker benefits as a result of the acquisition. These initiatives come on the coattails of The Corporate Crimes Against Health Care Act of 2024 put forth by Senators Ed Markey (D-MA) and Elizabeth Warren (D-MA). This Act seeks to advance new civil and criminal penalties for for-profit healthcare investors who are found responsible for initiating conditions that result in patient harm. 

While PE firms argue they provide proficiency and innovation, studies indicate that these advantages may come at the expense of patient care and accessibility and critics have likened the spread of this detrimental model to a “metastasizing disease.” The question remains: how can we balance the need for investment in efficient healthcare delivery models while maintaining patient health and positive outcomes as a priority? The introduction of state and federal regulations signals a step toward addressing this question. However, with Republican control of both the House and Senate beginning in 2025, restrictive legislation aimed at PE firms may face some considerable setbacks. Nevertheless, the debate over PE in healthcare is far from over and the healthcare industry’s profound transformation under this model will be something to keep an eye on. 

The Biden-Harris Administration recently proposed a rule expanding contraceptive coverage under the Affordable Care Act. Nearly 50 million Americans utilize the Affordable Care Act’s Marketplace for affordable healthcare insurance. The Affordable Care Act also protects over 100 million Americans with pre-existing conditions. On average, American families who use the Marketplace to acquire healthcare coverage save $800 per year.

Notably, the Affordable Care Act also provides millions of women with coverage for contraceptives, saving women billions. The Biden-Harris Administration’s proposed rule would expand the Affordable Care Act’s reach in the area of contraceptives, allowing for coverage of contraceptives purchased over-the-counter.

Currently, under the Affordable Care Act, private health plans must cover the complete cost-sharing of contraceptives prescribed by a provider. In other words, health plans must pay the full amount of all contraceptives accessed by their beneficiaries when prescribed by their healthcare provider. Under the new proposed rule, private health plans would be required to provide coverage for over-the-counter contraceptives, no longer requiring beneficiaries to obtain a provider’s prescription to get their contraceptives. Over-the-counter contraceptives include emergency contraceptives, such as the ‘morning after’ pill. Additionally, the proposed rule would expand the current list of contraceptives that private health plans are required to cover at no cost-sharing to beneficiaries. In sum, the proposed rule would greatly expand the already expansive Affordable Care Act relating to contraceptives.

The proposed rule comes off the heels of Republican congress members’ advocacy to defund the Title X Family Planning Program. Additionally, abortion rights and contraceptive access have been limited over the past years following the overturn of Roe v. Wade. Republican lawmakers advocate for reducing the amount of funds the federal government provides to abortion providers and contraceptive coverage. Specifically, following Donald Trump’s electoral victory these past weeks, Vice President-elect JD Vance has stated that “we don’t think that taxpayers should fund late-term abortions”, emphasizing the incoming administration’s desire to defund and minimize coverage for family planning. In turn, this would leave government protections and financial coverage of abortions and contraceptives to the states and private insurers.

On the other side, the Biden-Harris Administration has made clear its commitment to providing expansive and robust coverage for family planning services. However, as the administration changes with the incoming President-elect Donald Trump taking control, the future of women’s health and family planning remains uncertain. While the Biden-Harris Administration seeks to create a final, agency rule expanding the protection of contraceptive coverage, the incoming Trump Administration has signaled its desire to utilize Executive Orders to roll back Biden-Harris Administration rules. In sum, the future of contraceptive coverage, both under the Affordable Care Act and through private health insurers, remains vulnerable to significant rollbacks.